Provider Demographics
NPI:1982876520
Name:WILKS, RANDALL (AUD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:WILKS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 13TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4307
Mailing Address - Country:US
Mailing Address - Phone:256-355-6200
Mailing Address - Fax:256-355-6241
Practice Address - Street 1:1218 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4307
Practice Address - Country:US
Practice Address - Phone:256-355-6200
Practice Address - Fax:256-355-6241
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0872A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist